Provider Demographics
NPI:1427038272
Name:JORDAN, GERALD H (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-457-5110
Mailing Address - Fax:757-466-3411
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-457-5110
Practice Address - Fax:757-466-3411
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037957208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15921OtherSENTARA HEALTHCARE
340012060OtherRR MEDICARE
VA007501587Medicaid
VA340000494Medicare ID - Type Unspecified
VA340012115Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA007501587Medicaid